3875Discriminators algorithm integrated into implantable defibrillator: diagnostic capacity analysis and impact in the reduction of inappropriate therapies (original) (raw)

2017, European Heart Journal

Risk prediction for sudden cardiac death and ICD treatments 815 (11.7 million inhabitants) between 2006 and 2010, we identified characteristics associated with an increased risk of pre-hospital SCD and used these variables to build a SCD prediction score which we validated internally and externally. Results: In the overall STEMI population, (n=8112; median age 60 years, 78% males), SCD occurred in 452 patients (5.6%). By multivariate analysis, younger age, absence of obesity, absence of diabetes, shortness of breath, and a short delay between pain onset and call to EMS were the main predictors of SCA. A score built from these variables predicted SCA, with the risk increasing 2-fold in patients with a score between 10 and 19, 4-fold with a score between 20 and 29, and more than 18-fold with a score ≥30, compared to those with scores <10. The SCA rate was 28.9% in patients with a score ≥30 compared to 1.6% in patients with a score ≤9 (P for trend<0.001). Sensitivity and specificity varied between 96.9% and 10.5% for scores 10 and above, and 18.0% and 97.6% for scores 30 and above, with scores between 20 and 29 achieving the best sensitivity and specificity (65.4% and 62.6%, respectively). Conclusion: Anticipating the occurrence of SCD at the acute phase of STEMI is feasible, and it should be added to the survival chain as a new link immediately before SCD (Figure). Near-term can accordingly be developed as a novel approach to reduce the burden of SCD